COOK COUNTY (NPI# 1700400744) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1700400744 |
| Entity Type | Organization |
| Organization Name | COOK COUNTY |
| Practice Address |
12757 South Western Avenue Blue Island IL 60406 |
| Mailing Address |
1900 W Polk St Ste 220c Chicago IL 60612-3723 |
| Practice Telephone | 3128640200 |
| Enumeration Date | 2020-06-05 |
| Last Update Date | 2020-06-05 |
| Authorized Official Name | SCOTT ANDRLE (DIRECTOR OF MANAGED OPERATIONS) |
| Authorized Official Telephone | 3128644649 |
| Is Organization Subpart | Y |
| Parent Organization Name | COOK COUNTY |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Cook County Health at Blue Island | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578170221 | Cook County | Technician, Other | 430 East 51st Pl, Chicago, IL 60615 | 2020-09-28 |
| 1780205708 | Cook County | Family Medicine | 12757 S. Western Ave, Blue Island, IL 60406 | 2020-04-30 |
| 1457982340 | Cook County | Family Medicine | 15900 S. Cicero, Oak Forest, IL 60452 | 2020-01-29 |
| 1841500956 | Cook County | Pharmacy | 1901 W Harrison St Rm B178, Chicago, IL 60612-3714 | 2010-10-08 |
| 1770892135 | Cook County | Pharmacy | 1901 W Harrison St Rm 1230a, Chicago, IL 60612-3714 | 2010-10-04 |
| 1982724894 | Cook County | Clinic/Center | 450 E 51st St, Chicago, IL 60615 | 2007-04-02 |
| 1346360682 | Cook County | General Acute Care Hospital | 15900 Cicero, Oak Forest, IL 60452 | 2007-03-30 |
| 1194845495 | Cook County | Clinic/Center | 4859 S Wabash Ave, Chicago, IL 60615-1008 | 2007-03-30 |
| 1649390022 | Cook County | Clinic/Center | 12757 South Western Avenue, Blue Island, IL 60406 | 2007-03-30 |
| 1295855096 | Cook County | Clinic/Center | 1135 W 69th St, Chicago, IL 60621-1147 | 2007-03-29 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Oregon Corporations, Companies and Business Names | COOK COUNTY APARTMENTS LLC | 1515 Sw 5th Ave Ste 600, Portland, OR 97201 |
| System for Award Management (SAM) Entities | COOK COUNTY BLACK CHAMBER OF COMMERCE CORPORATION | 732 N Spaulding Ste 1r, Chicago, IL 60624-1541 |
| System for Award Management (SAM) Entities | COOK COUNTY BOARD OF HEALTH | 204 N Parish, Adel, GA 31620-2327 |
| System for Award Management (SAM) Entities | COOK COUNTY DEPT OF PUBLIC HEALTH | 15900 S Cicero Ave, Oak Forest, IL 60452 |
| System for Award Management (SAM) Entities | COOK COUNTY ELEMENTARY SCHOOL | 12300 S Greenwood Ave, Blue Island, IL 60406-1558 |
| System for Award Management (SAM) Entities | COOK COUNTY HEALTH | 1950 W Polk St, Chicago, IL 60612-3723 |
| System for Award Management (SAM) Entities | COOK COUNTY J T D C FOUNDATION | 1538 W Jackson Blvd, Chicago, IL 60607-5304 |
| System for Award Management (SAM) Entities | COOK COUNTY SOUTHLAND JUVENILE JUSTICE COUNCIL | 336 Forest Blvd, Park Forest, IL 60466-2005 |
| System for Award Management (SAM) Entities | COOK COUNTY SUBURBAN REDEVELOPMENT, LLC | 175 West Jackson Blvd, Chicago, IL 60604-2615 |
| Street Address |
12757 SOUTH WESTERN AVENUE |
| City | BLUE ISLAND |
| State | IL |
| Zip Code | 60406 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649390022 | Cook County | Clinic/Center | 12757 South Western Avenue, Blue Island, IL 60406 | 2007-03-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780205708 | Cook County | Family Medicine | 12757 S. Western Ave, Blue Island, IL 60406 | 2020-04-30 |
| 1942842810 | Blue Island Smiles PC | Dentist | 12059 Western Avenue, Blue Island, IL 60406 | 2019-10-12 |
| 1609438738 | Maisha Safford | Developmental Therapist | 2262 W. 120th Place, Blue Island, IL 60406 | 2019-06-28 |
| 1891279709 | Renjith Thomas | Physical Therapy Assistant | Therapy Department, 1546 W Water Stret, Blue Island, IL 60406 | 2018-09-18 |
| 1982182994 | Lifehouse Health Group,llc | Clinic/Center | 14127 Levitt Ave, Dixmoor, IL 60406 | 2018-08-01 |
| 1063923159 | Sarah Lynn Presser | Speech-Language Pathologist | 2975 W Broadway, Blue Island, IL 60406 | 2017-10-17 |
| 1174070676 | Aunt Martha's Youth Service Center | Clinic/Center | 12139 S. Western Ave, Blue Island, IL 60406 | 2016-09-01 |
| 1427429141 | Pamela Kilcrease | Case Manager/Care Coordinator | 2247 119th Street, Apt 6, Blue Island, IL 60406 | 2015-10-08 |
| 1639587025 | D2 Dental At Oak Street, P.C. | Dentist | 3046 West 127th Street, Blue Island, IL 60406 | 2014-07-29 |
| 1700299658 | Daniel Ahrens | Optometrist | 13114 S Western Ave, Blue Island, IL 60406 | 2014-06-09 |
| Find all providers in zip 60406 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811174105 | Humaira Khan | Family Medicine | 2310 York Street, 2a Pavilion, Blue Island, IL 60406-2428 | 2008-01-29 |
| 1023549821 | Patrick Hines | Family Medicine | 3046 127th St, Blue Island, IL 60406-1827 | 2017-03-23 |
| 1801273362 | Jaydeep Khudai | Family Medicine | 2320 High St, Blue Island, IL 60406-2426 | 2015-05-04 |
| 1275952731 | Avinash Mantha | Family Medicine | 3046 127th St, Blue Island, IL 60406-1827 | 2014-04-14 |
| 1609148139 | Blue Island Clinic Company LLC | Family Medicine | 12935 Gregory St, Blue Island, IL 60406-2428 | 2012-01-30 |
| 1093007221 | Daniel James Fitzgerald | Family Medicine | 12935 Gregory St, Blue Island, IL 60406 | 2011-05-05 |
| 1396074753 | Sa Padua Medical Center, LLC | Family Medicine | 2310 York St, Suite 2c, Blue Island, IL 60406-2411 | 2009-12-15 |
| 1932349040 | Francisco Pereiro | Family Medicine | 2320 High St, Blue Island, IL 60406-2426 | 2009-03-02 |
| 1225286412 | Msmc Investors, LLC | Family Medicine | 12935 Gregory St, Blue Island, IL 60406-2428 | 2008-09-03 |
| 1962603837 | Theodore G James Mdsc | Family Medicine | 13000 Maple Ave, Blue Island, IL 60406-2318 | 2007-05-30 |
| Find all providers in BLUE ISLAND | ||||
| City | BLUE ISLAND |
| Zip Code | 60406 |
Please comment or provide details below to improve the information on COOK COUNTY.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.